& ANSWERS WITH RATIONALES
1. The most likely cause of bilateral purulent
conjunctivitis in a 1-day old infant is
a. Gonorrheal opthalmia
b. Chlamydia infection
c. Symphilitic opthalmia
d. Adenovirus infection - ANSWER>>>a. Gonorrheal
ophthalmia
Rationale: Gonorrehea usually appears in the first 3-5
days of life. Chlamydia is between days 5-14. The other 2
are less common in neonates. Most common causes of
conjunctivitis in newborn includes, Chlamydia,
Gonorrhea, HSV, and chemical induced conjunctivitis.
(Burns)
2. Which of the following circumstances is most
suggestive of excessive stress in a family with a
chronically ill child?
a. The father takes a second job to meet financial
responsibilities
b. The mother provides the majority of the care for the
child
c. The parents stop participation in a support group
,d. A sibling exhibits decline in school performance -
ANSWER>>>c. The parents stop participation in a
support group
Rationale: Chronic illness takes a significant stress on the
family. It can result in changes in roles as well as the
sibling feeling unloved or left out in some way. Can also
result in depression/anxiety of parents and other family
members. Positive social networks are a positive
influence on parents and the PNP should be concerned if
the family is withdrawing from supportive social
networks. This could indicate depression or extreme stress
on the family unit. (Burns)
3. An otherwise healthy 2-year old boy is brought to the
emergency room with a four-week history of wheezing
and persistent cough. Prior to the start of these symptoms,
the parent recalls a coughing event which resolved
spontaneously. Of the following the most likely diagnosis
is:
a. Viral pneumonia
b. Acute laryngotracheobronchitis
c. Bronchiolitis
d. Foreign body aspiration - ANSWER>>>d. Foreign
body aspiration
, Rationale: An initial choking, gagging, or coughing
episode following by spontaneous resolution is often
present in history finding of a child with foreign body
aspiration. The episode is typically followed by
respiratory symptoms such as stridor, wheezing, and
prolonged cough in the absence of illness. Acute
layngotracheobronchitis, bronchitis, and viral pneumonia
are also associated with coughing and wheezing but also
involve other symptoms such as fever, rhinorrhea, fatigue
and usually resolve within 10-14 days. (Nelson Textbook
of Pediatrics 20th edition, Chapter 327)
4. The sexual development of a 14-year old girl is notably
delayed. She is very short, slightly obese, and complains
of constipation and fatigue. Her skin is sallow and coarse
in texture, and her hair is brittle. Which of the following
tests should be obtained?
a. Serum leutinizing hormone and chromosome analysis
b. Serum thyroxine and thryroid-stimulating hormone
c. Chromosome analysis and serum thyroxine
d. Serum leutinizing hormone and thyroid stimulating
hormone - ANSWER>>>b. Serum thyroxine and
thryroid-stimulating hormone
Rationale: Classic symptoms of growth failure, goiter,
delayed or arrested puberty, delayed dentition, weight
gain, fatigue, dry skin, hyperlipidemia, decline in school